Pelvic organ prolapse is common. In the United States, 24 percent of women have some type of pelvic floor disorder. See Nygaard I; Barber M D; Burgio K L; Kenton K; Meikle S; Schaffer J; Spino C; Whitehead W E; Wu J; Brody D J; Prevalence of Symptomatic Pelvic Floor Disorders in US Women; JAMA; 2008 Sep. 17; 300(11):1311-6. The Women's Health Initiative reported 34 percent of women had anterior vaginal wall prolapse, 19 percent had posterior vaginal wall prolapse, and 14 percent had uterine prolapse on physical examination. See Hendrix S L; Clark A; Nygaard I; Aragaki A; Barnabei V; McTiernan A; Pelvic Organ Prolapse in the Women's Health Initiative: Gravity and Gravidity; Am J Obstet Gynecol 2002 June; 186(6):1160-6. Population-based surveys have found that 4 to 10 percent of women report symptoms of pelvic organ prolapse. See Bradley C S; Nygaard I E; Vaginal Wall Descensus and Pelvic Floor Symptoms in Older Women; Obstet Gynecol. 2005 October; 106(4):759-66. Rortveit G; Brown J S; Thom D H; Van Den Eeden S K; Creasman J M; Subak L L; Symptomatic Pelvic Organ Prolapse: Prevalence and Risk Factors in a Population-Based, Racially Diverse Cohort; Obstet Gynecol. 2007 June; 109(6):1396-1403. Tegerstedt G; Maehle-Schmidt M; Nyren O; Hammarstrom M; Prevalence of Symptomatic Pelvic Organ Prolapse in a Swedish Population; Int Urogynecol J Pelvic Floor Dysfunct; 2005 November-December; 16(6):497-503; Epub 2005 Jun. 29.
Women are living longer and want to maintain their physique and capacity for sexual function well beyond menopause. Few maladies are more disruptive to these goals than pelvic organ prolapse, which is responsible for more than 200,000 surgical repair procedures each year (22.7 per 10,000 women) at an annual cost of more than $1 billion. See Boyles S H; Weber A M; Meyn L; Procedures for Pelvic Organ Prolapse in the United States, 1979-1997; Am J Obstet Gynecol 2003 January; 188(1):108-15. Subak L L; Waetjen L E; van den Eeden S; Thom D H; Vittinghoff E; Brown J S; Cost of Pelvic Organ Prolapse Surgery in the United States; Obstet Gynecol 2001 October; 98(4):646-51. Despite its prevalence, there is unfortunately no accurate, site-specific system for describing, quantifying, and staging pelvic support in women in order to provide a standardized means for documenting, comparing, and communicating clinical findings with proven interobserver and intraobserver reliability.
The most accurate system available as of today is the Pelvic Organ Prolapse Quantification system (POP-Q), which refers to a totally objective, examiner dependent, and complicated site-specific system for describing, quantifying, and staging pelvic support in women. See Bump, R C, Mattiasson, A, Bo, K, et al.; The Standardization of Terminology of Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction; Am J Obstet Gynecol 1996; 175:10. The POP-Q system is approved by the International Continence Society (ICS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse. It is the most common system used by gynecologists, although other systems have been devised. See Hall A F; Theofrastous J P; Cundiff G W; Harris R L; Hamilton L F; Swift S E; Bump R C; Interobserver and Intraobserver Reliability of the Proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society Pelvic Organ Prolapse Classification System; Am J Obstet Gynecol 1996 December; 175(6):1467-70; discussion 1470-1.
The POP-Q system suffers from the following weaknesses:
1) Difficulty of performance of the measurement secondary to patient body habitus and distorted anatomy.
2) It is completely objective: POP-Q measurements are totally operator dependant and therefore not very accurate. Unfortunately, most gynecologists worldwide lack an accurate technique for the measurement of pelvic organ prolapses.
3) Even in well trained operators the measurement of pelvic organ prolapse remains primarily based on objective measurements, and the operators tend to measure and score the numbers based on visual estimations rather than being based on real instrumental measurements.
4) the POP-Q system is unable to assess and quantify pelvic organ prolapse in the standing position. This is a big disadvantage given the fact that the worst occurrences of prolapse happen while in the standing position.
5) Although POP-Q is the most common method of describing pelvic organ prolapse used in research or peer-reviewed literature, the staging system was not cited or a non-standardized staging system was used in more than half of the studies. See Muir T W; Stepp K J; Barber M D; Adoption of the Pelvic Organ Prolapse Quantification System in Peer-reviewed Literature; Am J Obstet Gynecol 2003 December; 189(6):1632-5; discussion 1635-6. This illustrates the lack of reliability of the POP-Q system even for research purposes.
6) An accurate performance of POP-Q is time consuming and therefore does not make economic sense for many physicians.
In summary, performance of an accurate POP-Q exam in a gynecology office is very time consuming, difficult, objective, and overall not very accurate and reproducible. International surveys show that only 40.2% of International Continence Society (ICS) and American Urogynecology Society (AUGS) members routinely use the POP-Q system in their clinical practice. The results highlight some of the concerns regarding the complex nature of the system and its acceptance and use by specialists worldwide. It also suggests the need for a simplified version of the classification system that is user-friendly and that can be adopted by all practitioners. See Auwad W; Freeman R M; Swift S; Is the Pelvic Organ Prolapse Quantification System (POPQ) Being Used? A Survey of Members of the International Continence Society (ICS) and the American Urogynecologic Society (AUGS); Int Urogynecol J Pelvic Floor Dysfunction. 2004 September-October; 15(5):324-7; Epub 2004 May 18. The use of the POP-Q system is certainly much lower than 40% among typical gynecologists without specific urogynecologic training.
Accordingly, there is an immediate need for improved methods and devices for measuring pelvic organ prolapse.